Friday, September 29, 2006

The American Heart Association has apparently concluded that an observed 27% decline in heart attack admissions in Pueblo, Colorado within 18 months of implementation of a smoking ban is attributable to a reduction in secondhand smoke exposure.

In an article in the Pueblo Chieftain, the American Heart Association president stated: "The development of atherosclerosis that leads to a heart attack usually takes 20 years. The decline in the number of heart attack hospitalizations within the first year-and-a-half after the smoking ban that was observed in this study is most likely due to a decrease in the effect of secondhand smoke as a triggering factor for heart attacks. The ordinance will likely continue to decrease the number of heart attacks and save lives every year."

The Rest of the Story

I have already outlined the reasons why I don't believe the Pueblo study provides adequate evidence to support a conclusion that the observed decline in heart attack admissions was attributable to the smoking ban in the first place.

However, for the purposes of this post, let's stipulate that the decline was attributable to the smoking ban. How is the American Heart Association able to conclude that the reduction in heart attacks was due to reduced secondhand smoke exposure, as opposed to an effect on the prevalence of intensity of active smoking among smokers?

The study collected no information on the smoking status of heart attack patients, no information on changes in levels of secondhand smoke, and no data on changes in smoking prevalence, smoking intensity, or cigarette consumption. Thus, it is impossible to draw any conclusions about whether the heart attack decline (if indeed due to the smoking ban) was attributable to reduced secondhand smoke exposure or reduced levels of active smoking.

If anything, the more plausible hypothesis would be that any reduction in heart attacks would be predominantly attributable to smoking cessation. After all, there is abundant evidence that smoking cessation can reduce heart attack risk dramatically, and in a relatively short time period. There is, however, no similar evidence regarding secondhand smoke.

Moreover, the mechanism that is being postulated as explaining the reduction in heart attacks due to secondhand smoke exposure (that secondhand smoke exposure, even for brief periods, can trigger heart attacks by interfering with endothelial function and increasing platelet activity) would hold equally well for active smoking (since active smoking also interferes with endothelial function and increases platelet activity).

The Heart Association's reasoning here makes no sense. I think one has to question why they are jumping to such a premature and unsupported conclusion. The only explanation I can think of is that they are so anxious to provide support to the push for smoking bans that they are jumping on the opportunity to link secondhand smoke exposure with people dropping dead on the spot from heart attacks. That type of evidence could convince reluctant policy makers to enact smoking bans.

While I support workplace smoking bans, I do not support the idea of relying upon shoddy science to promote such bans. And I certainly do not approve of the intentional manipulation of the public's understanding of the scientific issues regarding secondhand smoke in order to promote our cause.

Here, I think the conclusions being drawn are unsupported by the scientific evidence (even if one blindly accepts that the reduction in heart attacks in Pueblo was due to the smoking ban, a conclusion which I do not believe is reasonable in the first place).

Wednesday, September 27, 2006

A study published online this week ahead of print in the journal Circulation concludes that the smoking ban in Pueblo, Colorado resulted in a 27% decline in hospital admissions for acute myocardial infarction (heart attacks).

The study ascertained the number of hospital admissions for acute MI in Pueblo for 18 months before and 18 months after the implementation of a smoke-free bar and restaurant ordinance. Poisson regression was used to analyze monthly counts of heart attack admissions and to compare the counts prior to the ordinance with those after the ordinance took effect. A neighboring county without a smoking ordinance (El Paso County) served as a comparison group.

The number of heart attack admissions in Pueblo declined by 27%, from 399 to 291, while there was no significant decline in heart attacks in El Paso County (from 984 to 955) during the same period.

The regression analyses indicated that there was a significant difference in monthly heart attack counts in Pueblo from before to after the smoking ban, and this difference remained significant after accounting for seasonal differences in the occurrence of heart attacks. The study concludes that: "A public ordinance reducing exposure to secondhand smoke was associated with a decrease in AMI [acute myocardial infarction] hospitalizations in Pueblo, Colorado, which supports previous data from a smaller study."

The Rest of the Story

While it would be nice to think that a smoking ban could produce an almost instantaneous dramatic effect on heart attacks as this article leads us to believe, this study unfortunately fails to provide adequate evidence to reach such a conclusion.

There are two major problems with the study which are so severe that in my view they invalidate the study conclusions and make the assertion that the smoking is responsible for the observed changes in heart attack rates premature.

First, the study is unable to control for the very real possibility that the observed changes in heart attacks simply reflect random variation in this phenomenon. If one looks at the year-to-year variation in heart attack admissions in a relatively small population like Pueblo, one will see that there is substantial variation, or instability in the data. There are relatively large increases and declines from year to year that occur simply by chance. Because this study only looked at heart attack admissions for a 1 1/2 year period before and after the smoking ban, it is unable to assess the level of random variation in the underlying data and therefore unable to determine whether the observed changes in heart attack rates are due to the smoking ban or simply due to random variation in the data that could have been observed in the absence of the smoking ban.

Essentially, this is a study with 2 data points: one before the ordinance (399) and one after the ordinance (291). Is the drop from 399 to 291 significantly more than one would observe from year to year (or 18-month period to 18-month period) due simply to random variation? It is impossible to know because the study does not go back or ahead any further than 18 months.

The second major problem is that because the study does not go back more than 18 months prior to the ordinance, it is also impossible to assess whether the observed decrease in heart attacks simply reflects secular changes that may have been occurring in heart attack admissions in Pueblo anyway, irregardless of the smoking ordinance. One cannot even evaluate this possibility because you cannot assess a trend when you only have one data point prior to the ordinance. The 18-month baseline period does not allow enough time to assess pre-existing secular trends, since these trends take place over a period of several years.

The combination of the study's failure to be able to assess whether the observed decline in heart attack admissions is attributable to random variation and whether the decline is attributable to secular changes in heart attacks in Pueblo render its conclusions invalid. A reasonable alternative explanation to the study conclusions exists: that the observed changes in heart attacks are due to a combination of random variation and to a secular trend of declining heart attack admissions.

The dangers of drawing the kind of conclusions being drawn from the Pueblo study with this kind of data can be demonstrated by examining trends in heart attack admissions for the state of Colorado as a whole (available from the HCUPnet database).

Based on changes observed from 1997 to 1998 for the entire state of Colorado, which has a substantially higher number of total heart attacks than Pueblo (about 17 times higher), one would have concluded that something happened in 1998 which resulted in a 16.4% increase in heart attack admissions.

My guess is that it was the Denver Broncos winning the Super Bowl in January 1998. That must have shocked so many long-time Broncos fans that it caused innumerable heart attacks.

But this is exactly the type of reasoning that is being used to support the Pueblo study conclusions.

In fact, for the entire state of Colorado, there was a 12% decline in heart attack admissions from 2002 to 2004, indicating that there was indeed a secular trend of declining heart attacks during the study period. Does the fact that heart attacks apparently did not decline in El Paso County indicate that the absence of a smoking ban in that county protected its residents from heart attacks?

Obviously not, but again, this is the type of reasoning that is being relied upon to draw the conclusions in the Pueblo study.

Another significant problem with the Pueblo study conclusion is that the research was not able to ascertain whether the heart attack patients were smokers or not. Thus, the paper provides no idea of the extent to which the observed decline in heart attacks was attributable to a decline among smokers or among nonsmokers. This makes it impossible to evaluate the plausibility of the study's conclusions, because the study is unable to determine whether a decline in smoking by active smokers precipitated by the smoking ban or a decline in secondhand smoke exposure is the mechanism by which the purported effect on heart attacks occurred.

Yet another problem is that the study failed to examine whether the ordinance actually resulted in substantial changes in secondhand smoke exposure and smoking behavior. How much did secondhand smoke exposure decrease? How many people experienced such a significant decline in their exposure? Did the smoking prevalence decrease, and by how much? Without answers to any of these questions, it is far too premature for the study to be drawing conclusions as sweeping as this one does.

In addition, and perhaps most importantly, the Pueblo study conclusions are implausible on their face. Even if the ordinance completely eliminated secondhand smoke exposure for everyone in Pueblo, one would not expect to see a 27% in heart attacks within 2 months. And even if the ordinance caused every smoker in Pueblo to quit smoking, one would only expect to see about a 27% long-term decline in heart attacks.

Finally, by chance alone, heart attack admissions would be expected to fall in some cities following smoking bans. Showing that heart attack admissions did fall in one particular city does not demonstrate that it had anything to do with the smoking ban. It could simply be a chance finding. To draw that conclusion, one would need evidence from a large number of different cities.

It's kind of like concluding that a smoking ban caused an increase in restaurant sales because in one particular establishment, the sales went up significantly after the smoking ban. Even assuming that the increase in sales was real, it does not indicate that the increase was attributable to the smoking ban. By chance alone, sales in some establishments are going to increase. To conclude that the smoking ban had an effect on sales, one would have to sample a decent number of these establishments.

Yet concluding that the smoking ban reduced heart attacks in Pueblo based on these study results is essentially the equivalent of concluding that a smoking ban resulted in increased restaurant sales because in one restaurant, sales went up.

In my view, this is an example of really shoddy science. Not the study itself. But its conclusions.

Equally shoddy is the propaganda based on the study that is already being spewed by anti-smoking groups. The Campaign for Tobacco-Free Kids, for example, stated in its press release about the new study that: "These studies add to the overwhelming evidence that secondhand smoke poses serious, even life-threatening risks to health... ."

However, this study says nothing about secondhand smoke. Even if one fully accepts the conclusion, it does not add any evidence about the harms of secondhand smoke. The observed effects could just as easily be due to reduced active smoking. In fact, that is the more likely explanation for any actual observed effects of a smoking ban on heart attacks.

I really fear that this shoddy science on the part of the anti-smoking movement is going to harm our credibility. Junk science is supposed to be the hallmark of the tobacco companies. Why are we now embracing it as our own?

Tuesday, September 26, 2006

Earlier today, I revealed that a Minnesota anti-smoking group - ClearWay (formerly MPAAT) - is actively deceiving the public about important information regarding secondhand smoke by misrepresenting the acute cardiovascular effects of secondhand smoke exposure. In their smoking ban manual on their web site, ClearWay claims that eating in a smoky restaurant increases your risk of heart disease by 30%. Not eating in a smoky restaurant every day of your life, I might add. Just eating (presumably once) in a smoky restaurant:

"Current scientific data suggest that eating in a smoky restaurant can precipitate myocardial infarctions in nonsmokers and increase the risk of fatal and non-fatal cardiac events in nonsmokers by about 30 percent."

As I pointed out, the claim that eating in a smoky restaurant increases your heart disease risk by 30% is not just a misleading or deceptive claim, it's completely fallacious.

But if one actually stops to think about the implications of ClearWay's public claim, which I think we (tobacco control practitioners) should, the ramifications are absurd (and perhaps comical).

The Rest of the Story

According to ClearWay, eating in a smoky restaurant increases your chances of suffering a heart attack by 30%. Thus, eating in a smoky restaurant twice increases your heart attack risk by 69%. And if you eat out five times in a smoky restaurant, then you face 3.7 times the baseline risk of having a heart attack. Since the relative risk of heart attacks for smokers is, least conservatively, about 3, this means that eating out in a smoky restaurant five times put you at a greater risk of a heart attack than an active smoker.

It also suggests that if you're making a choice between quitting smoking and stopping going to smoky restaurants, you're better off stopping going to smoky restaurants.

I should also note that according to my calculations based on this claim, if you eat out 19 times at a smoky restaurant, you are almost guaranteed to have a heart attack.

Perhaps restaurants that allow smoking should start offering promotional specials for customers who return 19 times. On your 19th visit, they serve you a free meal, calling it: heart attack on a plate.

An editorial in yesterday's St. Paul Pioneer Press criticized two Minnesota anti-smoking groups - ClearWay Minnesota (formerly known as MPAAT) and the Association for Nonsmokers - for withholding data that may indicate a drop in patronage in St. Paul bars following implementation of a smoking ban.

The details of the story are not entirely clear, but from what I can discern, here is my understanding of what happened:

On August 30, ClearWay Minnesota and the Association for Nonsmokers issued a press release announcing the results of a study they had commissioned which showed a dramatic 93% decline in particulate levels in a sample of 10 bars after implementation of St. Paul's smoke-free ordinance. The ban went into effect on March 31; apparently, the pre-ban samples were taken in March and the post-ban samples were taken in April. The 10 bars sampled represent a small proportion of the 200 or so bars and restaurants in the city.

These results were reported in several newspaper articles, including a Pioneer Pressarticle by reporter Jason Hoppin ("Smoking Ban Clears Air in Bars, Study Says").

Apparently, the newspaper reporter had made a request for all of the data upon which the study conclusions were based.

But according to the paper, "it took a Minnesota Data Practices Act request and a Minnesota Department of Administration advisory opinion for the Pioneer Press to get a look at the raw data from the study, which ClearWay was none too eager to share."

This is where the details are unclear to me. It seems that a court decision of nearly a year ago had already made it clear that these type of data are public and subject to disclosure. So why would ClearWay "hide" the data? Equally confusing is the apparent fact that Jason Hoppin's article on the study appeared on August 30, but on the very next day, his blog entry appeared which reported the "other" data in the study, which revealed the lower levels of patronage in this sample of 10 bars.

So it's not clear:(1) why Hoppin did not report all of the data in his August 30 article; did he feel that the patronage data were not worthy of including in the newspaper, but just in the blog?(2) why the newspaper suggests that ClearWay hid the data, since it appears that they released the data immediately (if the press release was issued on August 30, and Hoppin reported the patronage results the next day).

At any rate, what is clear is that these data show a rather large difference in the number of customers present in the bars before and after the smoking ban went into effect, with a much smaller number of customers present in the bars afterwards (average of a 38% decrease in patronage).

The Rest of the Story

It's difficult to assess what occurred here without all the facts. Apparently, the newspaper got the impression that ClearWay was attempting to suppress some of the data from the study. In fact, the newspaper goes so far as to suggest that these anti-smoking groups were intentionally deceiving the public about the findings of their study:

"We also believe there is a clear line between exaggeration and purposeful deception; the Association of Nonsmokers and ClearWay Minnesota (formerly MPAAT) crossed that line. An Aug. 30 press release by the Association of Nonsmokers not only expressed a conclusion about the air quality in St. Paul bars and restaurants that was based on insufficient data, the Association and ClearWay, which commissioned the study, withheld data relevant to the issue but contrary to their pro-ban position. As reported on the Pioneer Press blog "City Hall Scoop," it took a Minnesota Data Practices Act request and a Minnesota Department of Administration advisory opinion for the Pioneer Press to get a look at the raw data from the study, which ClearWay was none too eager to share. Why? Perhaps because the disaggregated data showed a wide variation in air quality among the 10 bars and restaurants tested - an insufficient sampling of the 200-plus in the city. The study also found a drop in patronage in seven of the 10 establishments tested. (Opponents of the smoking ban have consistently argued that the smoking ban has hurt business.) Interestingly, in the seven bars where patronage dropped, the air quality improved significantly more than in three bars where the customer counts went up. None of this data, however, was made public."

It's not clear to me whether the paper is accusing the anti-smoking groups of merely failing to report the data on bar patronage or whether the paper is suggesting that these groups actively hid the data, by failing to provide the data to the newspaper. Again, it appears that the newspaper was given the data, so I can only guess that the first accusation is the relevant one here.

Are these data important? I would argue that they are. One could make an argument that these data are not of much meaning because the sample was small (only 10 bars), the sampling conditions (e.g., days and times of sampling) from before to after the ban were very different, or that there are many other factors that affect patronage (such as seasonal variations).

However, it does seem to me that whatever arguments there are to suggest that the patronage data are not valid would also hold for the exposure data. Apparently, an attempt was made to sample the bars at the same times and days of the week. Apparently, the sample was deemed large enough to draw a definitive conclusion about exposure levels in St. Paul bars. So it seems to me that if the study was good enough to obtain meaningful data on exposure, perhaps it was also good enough to obtain meaningful data on the number of patrons. Moreover, the number of patrons present is an important variable in assessing the reasons for the decline in smoke levels.

While the difference in month of sampling is quite significant, it seems to me that if anything, one would expect to see more bar patrons in April than March, not fewer. Bar and restaurant sales data do confirm that spring is the season in which patronage is the highest.

Am I arguing that these data provide conclusive evidence that bar patronage decreased in St. Paul due to the smoking ban? No. I think the sample is too small to make such a determination and also, it appears that only one sample was taken in each bar. Nevertheless, I do think these data are relevant, especially given the importance that was attributed to the exposure data based on the same sample and sampling conditions.

Do I think the anti-smoking groups hid anything? I don't think they actively withheld the data, although it's not exactly clear why the newspaper got that impression.

One thing is clear about ClearWay, however. They are actively deceiving the public about important information regarding secondhand smoke. Specifically, I believe they are deceiving the public about the acute cardiovascular effects of secondhand smoke. In their smoking ban manual on their web site, they claim that a brief exposure to secondhand smoke decreases coronary blood flow in young, healthy individuals:

"Blood flow in the coronary arteries is decreased in healthy young adults exposed to secondhand smoke."

I think this claim is wildly misleading and deceptive. The truth is that exposure to secondhand smoke has been found not to affect basal coronary blood flow in healthy adults. In fact, the same study upon which this statement is based is the one that actually reports no difference in the blood flow in the coronary arteries of exposed adults.

Sure, the coronary reserve flow is reduced in exposed nonsmokers, but this reserve flow reduction is simply an indication of endothelial dysfunction, and it has no acute clinical significance.

I think it is irresponsible to mislead healthy young adults and to scare them by thinking that if they are exposed to secondhand smoke, the blood flow in their coronary arteries is going to decrease. It is not, and the claim is therefore wildly misleading.

Unfortunately, this is not the worst of it. Elsewhere in the same manual, ClearWay claims that eating in a smoky restaurant increases your risk of heart disease by 30%. Not eating in a smoky restaurant every day of your life, I might add. Just eating (presumably once) in a smoky restaurant:

"Current scientific data suggest that eating in a smoky restaurant can precipitate myocardial infarctions in nonsmokers and increase the risk of fatal and non-fatal cardiac events in nonsmokers by about 30 percent."

There is no evidence that eating in a smoky restaurant causes heart attacks in nonsmokers, but that's not the part of the claim that I'm most concerned about. The part I'm concerned most about is the claim that eating in a smoky restaurant increases your heart disease risk by 30%. Because that's not just a misleading or deceptive claim, it's completely fallacious.

The scientific evidence shows that chronic exposure (over many years) may increase your risk of heart disease by 30%. But eating once in a smoky restaurant? Obviously, this claim is false.

Let's give ClearWay the benefit of the doubt and assume that this is just a careless mistake and not an intentional lie. It needs to be corrected immediately, in either case.

I don't happen to think that there is any foul play in ClearWay's failure to disclose the data on smoking patronage; however, looking at the deceptive and fallacious health claims they are making doesn't add a whole lot to my contention.

If we are going to assume that ClearWay is being open and objective and scientifically careful and honest in all of its dealings, then we can certainly expect them to be accurate in their public communications. But a wildly misleading claim and a completely fallacious one don't qualify.

The rest of the story is that whether it's true or not, the public is getting the impression that we as anti-smoking groups have something to hide, and that we're exaggerating data or actively deceiving the public because the actual science doesn't fully support our position. The dissemination of deceptive health claims and the refusal to respond appropriately to the criticism of the invalidity of those claims (unless ClearWay is different from the 86+ other groups which have failed to correct their inaccurate health claims) are not going to help this situation.

Actually, I'm not quite sure what the rest of the story is here: withholding information from the public or making the claim that eating in a smoky bar increases your heart disease risk by 30%. Given the absurd claims this group is making, I'm not sure I wouldn't call it a public service for them to withhold information from us!

Action on Smoking and Health (ASH), a Washington, D.C.-based anti-smoking organization, claims to have critical new information on the constituents of, and health risks of tobacco smoke that it says could be important for the public, both smokers and nonsmokers.

Here is what ASH says: "According to information released by the British government, cigarettes contain: a paint stripper, a toilet cleaner, a lighter fuel, the chemical in mothballs, a poison used in gas chambers, a rocket fuel, and many other deadly poisons. This information, now being disclosed for the first time, could help persuade smokers to quit. It can also serve as a wakeup call to nonsmokers that breathing drifting tobacco smoke can hurt them.

So, please learn all about this list of chemicals which has been revealed. Show the list to both smokers and nonsmokers. Now available, in an easily downloadable form, is the complete list, provided as a public service by Action on Smoking and Health (ASH)."

The Rest of the Story

Here's the catch: In order to obtain this critical health information that ASH is providing "as a public service," you have to pay them $25 and sign up as a member of their organization.

Not much of a public service after all, is it?

Actually, I find this irresponsible of a public health group. If you have new information that potentially affects people's lives - that shows constituents and health effects of tobacco smoke - then you should release that information to the public. I feel that is your obligation and duty.

To hide that information from the public, only to use it as a ploy to try to obtain money for your group, is irresponsible.

Is this really the way the anti-smoking movement wants its groups to operate?

Monday, September 25, 2006

Yesterday, I laid out my case for why I think the University of California should reject tobacco industry funding of its research program. Whether or not readers agree with my conclusion, I hope that the post at least made a contribution by setting out a perspective by which the question of research funding can be evaluated. Some may have the perception that my views are heavily biased by the fact that I am a long-time anti-smoking advocate. Here, I hope to dispel that idea, as I offer my case for why I think universities should also reject funding from the American Legacy Foundation, one of the largest anti-smoking groups in the country.

The Rest of the Story

As a condition for accepting funding from the American Legacy Foundation, schools must sign a statement agreeing not to take funding from any tobacco company for the duration of the grant. This clause in the grant conditions is known as Clause 12.

As explained in a recent Public Health Reportsarticle: "Grants awarded under this program required that the dean or CEO of the school of public health confirm that the school of public health does not currently accept nor will accept any grant or anything else of value from any tobacco manufacturer, distributor, or other tobacco-related company during the grant period. This restriction is a policy of the American Legacy Foundation and applies to all of the foundation's grantees and sub-grantees."

Thus, a School, in order to receive Legacy funding, has to agree that none of the researchers at the institution will accept tobacco funding. If I were to successfully apply for an American Legacy Foundation grant, then the conditions of that grant would mean that my colleagues at the School - all of them - would be bound from applying for funding from any tobacco-related company.

In other words, by virtue of my accepting a Legacy grant, the Foundation has succeeded in tying the hands of every researcher at my School in terms of the funding sources to which they can apply.

This (unlike the proposed UC policy of rejecting all tobacco funding outright) is a clear violation of academic freedom.

By agreeing to this funding restriction, a School is essentially allowing one foundation to dictate the sources of allowable funding for all of its faculty.

And that's a dangerous proposition.

Suppose a potential benefactor wished to bestow a huge, multi-million dollar gift on a School. But one condition of the gift would be that the School could not accept money from any organization that supports abortion rights (or gun control, or promotion of condom use, etc.). The restriction is clearly not acceptable, as it interferes with academic freedom and degrades the School's autonomy to make its own decision regarding its research program.

The same types of restrictions that Legacy has imposed could easily be used to allow private foundations to control the nature of, and source of funds for, research at universities, interfering with academic freedom on purely political or ideological grounds (which is arguably exactly what Legacy is doing).

In response to Clause 12, a number of Schools of Public Health protested, and eventually refused to sign the letter, thus putting them out of the running for Legacy grant funding. A particularly cogent explanation of the reasons for refusing to agree to the grant conditions was provided by the University of California.

None of the Schools which opposed, and ultimately refused to sign, the letter agreeing to the tobacco company funding restrictions did so because they wanted to take tobacco funding. They did so on the basis of the principle that these types of funding restrictions are unacceptable.

Of course, the ultimate irony of this whole story is that the American Legacy Foundation receives all of its funding from...... you guessed it: the tobacco companies!

So you can imagine how heavily the hypocrisy is spread out over the Legacy Foundation, to have the gall to say that taking tobacco money is fine for them, but completely unacceptable for anyone else.

Moreover, to make matters much, much worse, Legacy is now attempting to obtain funding to sustain its "truth" campaign from...... you guessed it: the tobacco companies!

Legacy is doing this by funding a front group - the Citizens' Commission to Protect the Truth - to push for tobacco company funding of the campaign. According to its web site, the Commission is working toward either voluntary or involuntary tobacco company funding to support the campaign: 'The Commission is seeking to persuade or force the tobacco companies to accede to court-supervised funding of the Public Education Fund through the Master Settlement Agreement (MSA), which they signed with the states in 1998."

Apparently, persuading the companies to fund Legacy by voluntarily continuing MSA payments would be acceptable to Legacy.

I don't think it's possible to be any more hypocritical than this.

Essentially, what Legacy is saying is that what Legacy is doing is so valuable that taking tobacco company money is justifiable, but no matter what anybody else is doing, taking tobacco money is completely unacceptable.

When the corrupt, filthy, criminal tobacco money hits anyone else's hands, it stays corrupt, filthy, and criminal, but when it hits Legacy's hands, it is immediately purified.

Maybe they run it through some sort of Holy Water, or something. Or have a Rabbi perform a special blessing?

Notice, by the way, that no where on the Commission's home page does it notify the public that the Commission is not some sort of independent group. Instead, it is funded by the American Legacy Foundation! Isn't that special? Funding a so-called citizens' group to support funding for... you! Sounds exactly like something the tobacco companies would do. But if you don't read the fine print on an entirely separate web page, you'll miss that small detail.

Under these circumstances, I do not find it acceptable for Schools to accept funding from the American Legacy Foundation. So like its benefactors, I would add Legacy to the short list of companies and organizations from which I would argue that universities should not accept research funding.

Saturday, September 23, 2006

Some opponents of a proposed policy by which the University of California (UC) would reject tobacco industry funding of its research have argued that such a policy would interfere with academic freedom on the part of its faculty members. They have also argued that rejecting funds from tobacco companies could put the University on a slippery slope that could lead to rejection of funding from other sources for inappropriate reasons.

Some supporters of the proposed policy have argued that UC must reject tobacco funding because it automatically taints the research and the research cannot possibly be conducted objectively.

Here, I argue that both of these arguments fail to hold water, and I attempt to re-focus the debate on what I feel is really the key issue.

First, why is this not a debate over academic freedom?

Because academic freedom does not include the freedom of university faculty members to accept research funding from any source they desire.

The academic freedom argument leads to the preposterous notion that a university has no right to interfere with the decision of its faculty to accept research funding from any entity, no matter how corrupt it might be and no matter how much it might undermine the basic integrity of the university.

Suppose that a researcher wanted to accept funding from the Nazi party to conduct some historical research. A group of faculty decided to protest this and urged the university to disallow this. Must the university allow the researcher to accept this funding in order to protect academic freedom? I hardly think so.

What about money being offered from the drug cartel, from a prostitution ring, from a group promoting marijuana use among children, or from a cult that brainwashes its members, some into committing suicide in honor of the cult's leader?

Obviously, there is nothing inappropriate about a university making a decision to reject funding from certain entities, and academic freedom has nothing to do with protecting the right of university faculty to accept money from any source under the sun.

The university has a vested interest in ensuring that its acceptance of funding from an entity does not destroy the integrity of, or conflict severely with, the basic mission and values of the institution.

The question, then, is not whether the rejection of money from a particular source threatens academic freedom, but whether or not the acceptance of money from the funding source would destroy the integrity of, or conflict severely with, the basic mission and values of the institution.

People may legitimately have differences of opinion about whether accepting funding from tobacco companies represents a conflict so severe that it degrades the integrity of the University and therefore needs to be rejected. But what the debate is not legitimately about is academic freedom.

Second, why does the slippery slope argument not lead to the conclusion that tobacco funding must be accepted by the University?

Because it is the University's responsibility to make the difficult judgments and decisions regarding the sources of funding for its research and programs.

If the University simply were to throw up its hands and say: "We will take money from anyone and everyone because if we reject funding from one group, we'll be on a slippery slope and may have to reject money from others," then it would abdicating its responsibility to ensure its own integrity by regulating the funding sources of its own institution.

Far from protecting the University from going down some sort of dark path, it would actually destroy the University's ability to protect its own integrity by forcing it to accept money from anyone who comes knocking at the door.

The point is this: the tobacco companies have come knocking on the door and a decision must be made on the merits of the case at hand, not based on the merits of other potential cases that could come to the door. If a decision is made to accept money based on the concern that future decisions may need to be made in the negative, then the University is essentially setting a policy that it is open to funding from anyone.

Most of us would agree that accepting money from the drug cartel would represent a degradation of a university's integrity so severe that such money should be rejected outright. And most of us would also agree that accepting money from the National Institutes of Health would not and that such money should be accepted. But between these two extremes lie middle ground where a difficult decision, in some cases, must be made. And this is precisely one of them.

If the proposal to reject tobacco funding at UC is to be argued down, then it needs to be argued down based on a demonstration that accepting such money will not degrade the integrity of the institution and/or conflict severely with the basic mission and values of the institution, not based on the argument that it somehow interferes with academic freedom or puts the University onto an unacceptable slippery slope. True, it is a slippery and difficult slope. But making these difficult decisions is exactly what the Regents are supposed to be there for. That's what leadership is all about.

Now, third, why is it that I argue that the debate is not properly one over the tainting of academic research?

Because there are mechanisms that could be used to help ensure the integrity of the research itself, and if those mechanisms are put in place, the argument that tobacco industry funding must be rejected fails.

If one is going to argue that tobacco industry funding must be rejected because it taints the research, then does not one also have to argue that pharmaceutical funding must also be rejected? There is no question that pharmaceutical funding of research can, and has, resulted in tainted research.

But most universities have chosen to deal with pharmaceutical company funding in a different way: mechanisms are put in place to ensure that the research is influenced as little as possible by the funding source. Research may be disallowed if the investigator has a financial interest in the pharmaceutical company, the companies may be disallowed from reviewing the research prior to publication or from having any say in the conduct and reporting of the research, etc.

If this were simply an issue of the objectivity of the research, then there would be no reason to have to reject tobacco industry funding outright. One could, instead, make sure that strict mechanisms were in place to ensure the integrity of the research.

The reason why I think the University of California should consider rejecting tobacco industry funding is that the acceptance of that funding tarnishes the name of the University by making it a pawn in the public relations efforts of a company that is guilty of engaging in an illegal racketeering, conspiracy, and fraud enterprise to deceive the American people about the harms of its products and which uses its funding of university research as part of its marketing of these deadly products to Americans.

In other words, I would argue that UC should reject tobacco funding not because such funding taints the research or because it makes it impossible for objective research to take place. Instead, I would argue that UC should reject the funding because by accepting tobacco money, it becomes a pawn in a public relations effort which is part of a broader conspiracy to defraud the American people and to promote a deadly product.

This I find inconsistent with the basic interests, mission, and value of the University.

My hope is that UC will make the "right" decision and reject tobacco industry funding because I do not want my alma mater to be used as part of a public relations campaign by companies that are adjudicated racketeers and that use their funding of university research to promote deadly products.

But if UC decides to continue to accept tobacco industry funding, I hope that they make the decision based on a determination that they do not feel that the acceptance of tobacco funding will interfere with the interests, mission, and values of the University by using it as a pawn in a public relations campaign to defraud the American people and promote a deadly product, rather than on the basis of the shallow argument that such a rejection of funding would represent an interference with academic freedom or put the University on an unacceptable slippery slope.

Thursday, September 21, 2006

As I reported here last Friday, University of California (UC) Regent and state Lieutenant Governor Cruz Bustamante is calling on the Regents to adopt a policy refusing tobacco industry funding of research at the University of California. In a September 13 letter to his fellow University of California regents, he condemned a UCLA study for reporting findings that go against the prevailing belief that secondhand smoke is a cause of lung cancer in nonsmokers and for its having been used by opponents of smoking bans to help defeat a smoking ordinance in Missouri. He states that the tobacco companies are unlawful conspirators and that accepting tobacco money is "bad business."

The Rest of the Story

The rest of the story is that according to the San Francisco Chronicle, Bustamante apparently accepted nearly $80,000 from Big Tobacco during his time as a state Assembly member.

According to the article: "It is a surprising position for Bustamante, whose staff acknowledged he took almost $80,000 from tobacco companies during his five years in the state Assembly."

According to research from UCSF, Bustamante accepted more than $60,000 in Big Tobacco funding during the 1995-1996 legislative session alone: "Both Assembly Speaker Cruz Bustamante (D-Fresno) ($63,750) and Senate President pro Tempore Bill Lockyer (D-Hayward) ($127,875) received more money that U.S. House of Representatives Speaker Newt Gingrich ($30,500)."

Accepting money from corporations to allow them to buy influence in policy making is apparently not something that Bustamante has always thought was problematic. According to another San Francisco Chroniclearticle, Bustamante is "the politician who received the largest fine ever levied by the Fair Political Practices Commission."

The article explains that "Bustamante was fined $263,000 by the FPPC for improperly moving $3.8 million between campaign committees during the election to recall Gray Davis. He took $8 million from Indian tribes in the recall, and he later took $120,000 from the same insurance industry groups he wants to regulate."

Bustamante also apparently crafted a new technique to help him evade campaign contributions laws. According to the California Nurses Association web site: "The ballot process has been further corrupted by the new technique pioneered by Cruz Bustamante and perfected by Arnold Schwarzenegger, in which candidates for public office use ballot measure committees to evade the state's contribution limits. Bustamante, Schwarzenegger, and Phil Angelides have all used these committees, which are currently not subject to any limits on the size of contributions they can receive, to advance themselves as candidates."

To make matters worse, according to the Foundation for Taxpayer & Consumer Rights, Bustamante has a poor understanding of what is meant by conflict of interest. The Foundation states that Bustamante, "running all but unopposed in the Democratic primary for the post of state insurance commissioner, has taken at least $120,000 in contributions from insurance companies in the past year (as of Feb. 2006) and accepted free meals and travel from the industry he seeks to regulate, a blatant conflict of interest. He also failed to report some of the industry-paid travel on his campaign disclosure statements."

This allegation is supported by a San Francisco Chroniclearticle: "Lt. Gov. Cruz Bustamante, the leading Democratic candidate for state insurance commissioner, has taken large contributions and accepted free meals and travel from the industry he seeks to regulate. In the past year, Bustamante has received more than $120,000 in campaign donations from insurance companies, their trade groups and individual brokers, records show. He and top aides also have accepted from those in the insurance industry hundreds of dollars in free meals and travel expenses at restaurants and resorts in Pebble Beach, Las Vegas and San Diego -- some of which Bustamante did not report on his disclosure statements, according to records."

According to a Salon.com article, entitled "A Crisis in Democracy," Bustamante's acceptance of Big Tobacco funding was influential in his legislative actions. Salon writes that "Big Tobacco has gotten its money's worth."

In light of the rest of this story, Bustamante calling on the UC Regents to reject tobacco company funding of research reeks of hypocrisy. How much credibility does he exactly have when he himself accepted tens of thousands of dollars in Big Tobacco money? How much integrity does he appear to have in arguing that it is wrong for UC to take tobacco money, but not for him.

I guess tobacco money only corrupts when it is in the hands of researchers, not politicians.

I should mention, before closing, that it is always possible that Bustamante has had some sort of epiphany and that he is a completely reformed individual who has changed his views and his ways. But if that's the case, then he needs to admit that he erred and publicly apologize for his past actions in order to gain credibility.

I should also mention that this story has no impact on my support for the proposed policy of rejecting tobacco funding at UC. Readers familiar with my position on this issue will understand that I support the proposal because I think accepting tobacco money conflicts with the basic mission of the University, which has nothing to do with serving as a public relations pawn of the tobacco industry, an industry which has been found guilty of racketeering.

But the irony here is just too much to pass up. And I think those who truly support integrity, honesty, and the highest standards of research as well as public governance need to call out Bustamante on this issue. Sure, I think he is supporting a worthwhile cause. But to turn a blind eye to his own hypocrisy would, in the long run, only serve to condone the very problem that we are trying to confront with the UC Regents proposal.

Wednesday, September 20, 2006

In spite of the failure of every major scientific body that has reviewed the evidence to conclude that secondhand smoke causes pulmonary emphysema, at least 25 anti-smoking groups, headlined by the Campaign for Tobacco-Free Kids, American Cancer Society, and SmokeFreeOhio, are making precisely such a claim.

The California Environmental Protection Agency report on secondhand smoke, which is probably the most comprehensive review of the subject and which drew the controversial (even within the tobacco control community) conclusion that secondhand smoke causes breast cancer, did not even suggest that secondhand smoke causes pulmonary emphysema in nonsmokers.

In fact, the report stated that any effects of secondhand smoke on chronic lung function in nonsmokers are limited to small decrements in lung function, and is mainly in the form of exacerbating symptoms of patients with existing chronic lung disease:

"While lung function effects are less pronounced in adults than in children, ETS exposure appears to play a role in the genesis of chronic lower respiratory tract symptoms in otherwise healthy individuals and produces small, but measurable, decrements in pulmonary function. In adults, exposure to ETS at home and/or work was less associated with the onset of respiratory illness but rather with the aggravation of the symptoms and severity of existing bronchitis, sinusitis and emphysema."

The Surgeon General, in his comprehensive report on secondhand smoke, also fails to conclude that secondhand smoke is a cause of emphysema. He mentions that there is suggestive evidence, but it is not adequate enough to support a causal conclusion at this time:

"The evidence is suggestive but not sufficient to infer a causal relationship between secondhand smoke exposure and risk for chronic obstructive pulmonary disease."

Yesterday, I highlighted a number of shoddy scientific claims being communicated to the public by SmokeFreeOhio, including the conclusion that secondhand smoke causes emphysema. To my surprise, it now turns out that a large number of anti-smoking groups are implicated in prematurely communicating to the public that secondhand smoke causes emphysema, including such prominent groups as the Campaign for Tobacco-Free Kids and the American Cancer Society.

Here is a run-down of groups that are making this claim:

SmokeFreeOhio: "Secondhand smoke can cause the debilitating disease pulmonary emphysema, causing severe damage to the walls of the air sacs, with the lungs losing their capacity to expand and contract."

Campaign for Tobacco-Free Kids: "In addition to lung cancer, secondhand smoke is proven to cause heart disease, emphysema and other illnesses and is responsible nationally for thousands of deaths each year."

ASH (UK): "Secondhand Smoke Linked to Lung Disease in Young People. As many as one in nine young adults living in industrialized countries are at risk of developing a deadly lung condition known as chronic obstructive pulmonary disease (COPD). Smokers are particularly likely to get the disease. But people who inhale secondhand smoke are at risk too."

Center for Media and Democracy: "In 1986, U.S. Surgeon General C. Everett Koop released an analysis concluding that secondhand smoke was a significant health threat to nonsmokers, and a host of other studies by prominent health organizations have reached similar conclusions. The most common and serious effects are asthma, emphysema, and heart disease."

Campaign for Tobacco-Free Kids: "In addition to these new findings, secondhand smoke is scientifically proven to cause lung cancer, heart disease, emphysema and other illnesses and is responsible nationally for thousands of deaths each year."

SmokeFreeSociety: "Those most affected by secondhand smoke in our homes are children, as they are exposed to the hazardous poisons that can hinder the growth of their lungs and put them in danger of severe respiratory diseases. Children are being stricken at early ages by asthma and emphysema."

American Cancer Society: "Secondhand smoke also causes as many as 40,000 deaths from heart disease every year. Plus, it causes emphysema and lung disease, and also increases the risk that babies will die of Sudden Infant Death Syndrome."

Easy Breathing Avon: "The harmful effects of second hand smoke are well known. Secondhand smoke exposure can lead to: Heart Disease, Lung Cancer, and emphysema..."

The Rest of the Story

I guess I don't understand anymore why we in tobacco control need a Surgeon General's report, or any other scientific reviews of medical and epidemiologic science for that matter.

If we are going to communicate to the public that a causal relationship has been proven between secondhand smoke and emphysema without waiting for there to exist sufficient scientific evidence to draw such a conclusion, then what does it matter what the Surgeon General's report, or any other careful scientific review says?

Why don't we just take the slightest bit of evidence about every possible association that secondhand smoke may have and tell the public that secondhand smoke causes that disease?

Frankly, I'm not sure I see any reason for me to continue with my research on the health effects of secondhand smoke. Anti-smoking groups appear to be so anxious to heighten the emotional impact of their messages and frighten the public that they do not need solid science to inform their communications any longer. My role as a producer of the science upon which to base our communications in tobacco control is apparently obsolete.

Shoddy science has taken over, and it has apparently infiltrated all the way up to the top. It's not even clear to me that anyone cares about the scientific integrity of the movement.

The shame of this all is that our credibility is going to take a big hit from all of this. In the name of trying to marginally increase the scare value of our message in the short-term, we are risking the long-term credibility of the movement.

I don't see how that tradeoff makes any sense.

It's not clear to me exactly how this all happens. The language of the claims seems quite similar, so perhaps it just takes one organization to make the claim and then other organizations follow, without carefully checking the validity of the claim before making it themselves.

After 21 years of what I consider to be rigorous scientific research on secondhand smoke and other aspects of tobacco control, it deeply saddens me to see the lack of scientific integrity that now characterizes the anti-smoking movement.

Tuesday, September 19, 2006

A supposed "fact sheet" put out by SmokeFreeOhio claims that secondhand smoke causes the debilitating lung disease known as pulmonary emphysema.

According to the fact sheet: "Secondhand smoke can cause the debilitating disease pulmonary emphysema, causing severe damage to the walls of the air sacs, with the lungs losing their capacity to expand and contract."

The Rest of the Story

There is not sufficient evidence to support the claim that secondhand smoke causes emphysema. Even the Surgeon General, in his comprehensive report on secondhand smoke, failed to conclude that there is a causal relationship between secondhand smoke exposure and chronic obstructive lung disease.

Most worrisome to me is that the SmokeFreeOhio claim comes in association with an apparent response to address comments I made 7 months ago about fallacious claims in SmokeFreeOhio's secondhand smoke "fact sheet." Why is this worrisome? Because it suggests that SmokeFreeOhio was paying careful attention to the details of the fact sheet, and that this was not some sort of careless, quickshod attempt to throw a fact sheet together.

This is troublesome to me, because it argues against one of the possible explanations for this inaccurate claim: that SmokeFreeOhio was just being very careless and threw this together without reviewing it. In contrast, it appears that SmokeFreeOhio paid great attention to the fact sheet, altering it to address the concerns I expressed, probably with the knowledge that the fact sheet would be under great scrutiny, as they knew that I had blogged the inaccuracies in the original version of the document.

So I'm left to conclude that this is either a deliberate attempt to pull the wool over the eyes of the public and make them think that secondhand smoke is a lot more hazardous than it actually has been proven to be, or it is scientific shoddiness that casts a dark cloud on the scientific credibility of the entire anti-smoking movement.

What is the support that SmokeFreeOhio provides to back up its claim that secondhand smoke causes emphysema? They cite one article: a 2003 study by Carnevali et al., published in the American Journal of Physiology, and entitled "Cigarette smoke extract induces oxidative stress and apoptosis in human lung fibroblasts."

You've got to be kidding me! They are taking this one study, an in-vitro study showing that cigarette smoke extract causes oxidative stress in cultured human fibroblast cells, and they conclude, therefore, that secondhand smoke causes emphysema.

The authors of the paper itself merely speculate that this may be a mechanism by which active smoking causes emphysema: "Cigarette smoke is a potent source of oxidative stress, DNA damage, and apoptosis for HFL-1 cells, and we speculate that this could contribute to the development of pulmonary emphysema in the lungs of smokers."

The California Environmental Protection Agency report on secondhand smoke, which is probably the most comprehensive review of the subject and which drew the controversial (even within the tobacco control community) conclusion that secondhand smoke causes breast cancer, did not even suggest that secondhand smoke causes pulmonary emphysema in nonsmokers.

In fact, the report stated that any effects of secondhand smoke on chronic lung function in nonsmokers are limited to small decrements in lung function, and is mainly in the form of exacerbating symptoms of patients with existing chronic lung disease:

"While lung function effects are less pronounced in adults than in children, ETS exposure appears to play a role in the genesis of chronic lower respiratory tract symptoms in otherwise healthy individuals and produces small, but measurable, decrements in pulmonary function. In adults, exposure to ETS at home and/or work was less associated with the onset of respiratory illness but rather with the aggravation of the symptoms and severity of existing bronchitis, sinusitis and emphysema. Among adult nonsmokers exposed to ETS, eye, nose and throat irritation, as well as odor annoyance, are the most commonly reported health complaints. These complaints occur at levels near or overlapping the odor threshold for ETS, making their prevention technically difficult in smoking-permitted buildings."

This essentially concludes that secondhand smoke does not cause emphysema in nonsmokers.

The Surgeon General, in his comprehensive report on secondhand smoke, also fails to conclude that secondhand smoke is a cause of emphysema. He mentions that there is suggestive evidence, but it is not adequate enough to support a causal conclusion at this time:

"The evidence is suggestive but not sufficient to infer a causal relationship between secondhand smoke exposure and risk for chronic obstructive pulmonary disease."

What is ironic about SmokeFreeOhio making this claim to the public is that this is the organization that has been blasting its opponent in a Ohio dueling ballot initiative contest for misleading the public!

I'm afraid SmokeFreeOhio has no business accusing anyone else of misleading the public. At least until they do some housekeeping and apologizing of their own.

Frankly, it is amazing to me how scientific claims made by anti-smoking groups continue to get more and more shoddy.

I fear this presents a severe problem for the anti-smoking movement. Our credibility is truly at stake. You just can't continue to make ridiculous and completely unsupported claims like this and expect that anyone is going to take you seriously.

But most disturbing to me is that we don't seem to be taking ourselves seriously. We don't seem to care about what is becoming an alarming lack of scientific integrity in the movement.

We're the ones who attack the tobacco companies incessantly for misleading the public and making unsubstantiated health claims. You'd think we would want to do a little better than this.

Possibly in response to The Rest of the Story pointing out scientific inaccuracies in its fact sheet on the health effects of secondhand smoke, SmokeFreeOhio has changed the fact sheet in an apparent attempt to eliminate its fallacious claims.

The anti-smoking group, which is pushing a smoke-free bar and restaurant ballot initiative that recently was approved for the November ballot, eliminated the following four fallacious scientific claims:

1. After twenty minutes of exposure to secondhand smoke, a nonsmoker's blood platelets become as sticky as a smoker's, reducing the ability of the heart to pump and putting a nonsmoker at an elevated risk of heart attack."

2. "Only 30 minutes of secondhand smoke exposure can cause narrowing of blood vessels, restricting the flow of blood and contributing to hardening of the arteries."

3."In that same 30 minutes, changes to your blood boost your risk of building up fat deposits that could lead to heart attacks and strokes."

4. "After 120 minutes of exposure, your heart rate variability is reduced, increasing the chance of an irregular heart beat that can itself be fatal or trigger a heart attack."Importantly, however, the group still claims that 20 minutes of secondhand smoke exposure increases a nonsmoker's risk of suffering a heart attack:

"After twenty minutes of exposure to secondhand smoke, a nonsmoker's blood platelets become as sticky as a smoker's, reducing the ability of the heart to pump and putting a nonsmoker at an elevated risk of heart attack.8"

The number 8 refers to a citation of a scientific article by Burghuber et al. which was published in the journal Chest in 1986.

In addition, SmokeFreeOhio now claims that secondhand smoke increases the risk of developing pancreatic cancer, based on the results of a single study: "Secondhand smoke increases your risk of developing pancreatic cancer."

And SmokeFreeOhio also lists diabetes in its list of diseases caused by secondhand smoke.

Further, SmokeFreeOhio now claims that secondhand smoke causes emphysema: "Secondhand smoke can cause the debilitating disease pulmonary emphysema, causing severe damage to the walls of the air sacs, with the lungs eventually losing their capacity to expand and contract."

Finally, in a separate fact sheet, SmokeFreeOhio now claims that the Surgeon General's report on secondhand smoke concluded that: "Breathing secondhand smoke for even a short time can have immediate adverse effects on the cardiovascular system and interferes with the normal functioning of the heart, blood, and vascular systems in ways that increase the risk of a heart attack."

The Rest of the Story

I view SmokeFreeOhio as being irresponsible in its reporting of the science of secondhand smoke to the public. They continue to mislead the public about the effects of secondhand smoke. But now they have increased the scope of their deceptive claims, going beyond simply acute cardiovascular effects. Now, diabetes, pancreatic cancer, and emphysema have been added to the list. And they continue to claim that just 20 minutes of exposure to secondhand smoke increases a nonsmoker's risk of suffering a heart attack.

Apparently, SmokeFreeOhio has admitted that its earlier claims were inaccurate, as I pointed out in March 2006, about 7 months ago. The fact that it took 7 months to correct these fallacious claims is bad enough. But SmokeFreeOhio failed to correct all of them. It still claims that a nonsmoker is at risk of dropping dead of a heart attack from just 20 minutes of secondhand smoke exposure!

It added a claim that the Surgeon General's report concluded that even a brief exposure to secondhand smoke increases the risk of a heart attack.

And to make things worse, SmokeFreeOhio now claims that secondhand smoke causes diabetes, pancreatic cancer, and emphysema.Finally, it does not appear that SmokeFreeOhio has apologized for what it apparently admits was widespread misleading of the public about the health effects of secondhand smoke.

There is so much that is deceptive in this so-called "fact sheet" that it is difficult to know where to begin.

Let's start with the retained fallacious claim.

"After twenty minutes of exposure to secondhand smoke, a nonsmoker's blood platelets become as sticky as a smoker's, reducing the ability of the heart to pump and putting a nonsmoker at an elevated risk of heart attack.8"

There is simply no evidence that 20 minutes of secondhand smoke exposure reduces the ability of the heart to pump. If anything, cardiac output has been shown to increase in response to acute secondhand smoke exposure. While the platelets are activated and do become "stickier," there is no evidence that this causes a heart attack to occur. It is not even plausible that 20 minutes of secondhand smoke exposure could cause a heart attack in someone who does not already have severe coronary artery stenosis.

The citation used to support the statement is a study of platelet activation in response to secondhand smoke exposure. It doesn't even examine heart attack risk. How can SmokeFreeOhio possibly make claims about heart attack risk from a study that simply measured platelet activity?

Now let's take the new fallacious claims.

First, nowhere did the Surgeon General's report conclude that: "Breathing secondhand smoke for even a short time can have immediate adverse effects on the cardiovascular system and interferes with the normal functioning of the heart, blood, and vascular systems in ways that increase the risk of a heart attack."

I reviewed the report in detail, and nowhere did I see any evidence that a brief exposure to secondhand smoke interferes with the functioning of the heart at all, much less in a way that increases heart attack risk. The report draws no such conclusion. In fact, what the report concludes is that chronic exposure to secondhand smoke increases heart disease risk.

Second, I am aware of no evidence that diabetes should be added to the list of diseases caused by secondhand smoke. It is true that there is some evidence that secondhand smoke exposure may cause a certain degree of glucose intolerance, but this does not support a contention that secondhand smoke causes diabetes.

This paper actually found no evidence for insulin resistance associated with secondhand smoke or active smoke exposure. While 11.6% of adolescents had high fasting glucose levels, 14.1% of secondhand smoke exposed subjects did, and only 9.6% of active smoking adolescents did.

These differences were not significantly different, and there was no trend evident. I think there are serious problems with concluding that secondhand smoke is even a cause of insulin resistance, much less of diabetes. And active smoking, while it may cause insulin resistance, is not even recognized as a cause of diabetes. Increased weight is, and to the extent that smoking may keep weight down, it's not so clear whether quitting smoking would reduce someone's risk of developing type II diabetes.

Third, the fact sheet draws a conclusion that secondhand smoke causes pancreatic cancer based on the results of a single study.

The California Environmental Protection Agency report on secondhand smoke, which is probably the most comprehensive review of the subject and which drew the controversial (even within the tobacco control community) conclusion that secondhand smoke causes breast cancer, did not even mention a risk for pancreatic cancer associated with secondhand smoke exposure.

SmokeFreeOhio has completely jumped the gun here, and has no sufficient basis (not even close) for claiming that secondhand smoke causes pancreatic cancer.

The most fallacious (if there are degrees of fallaciousness) claim made by SmokeFreeOhio is that secondhand smoke is a cause of pulmonary emphysema. This is not sufficiently supported by the evidence. I will deal with it in a separate post. For now, suffice it to say that SmokeFreeOhio's fact sheet is far more misleading, deceptive, damaging, and irresponsible than it was before they started mucking with it in an apparent attempt to address the concerns expressed 7 months ago by The Rest of the Story.

For an organization which is attacking its opponent for misleading and deceiving the public, I don't see SmokeFreeOhio as having a leg to stand on. They are engaging in a misleading campaign of their own, based on scientific untruths and completely fallacious claims.

The November ballot initiative battle is shaping up to be a contest between two groups which apparently are incapable of communicating the truth.

If you want a battle in Ohio between two groups that will fight with some integrity, rather than deception, I think you'll be better off to head to Columbus for the Michigan-Ohio State game.

One final note. In its original fact sheet, I made it clear that I was not accusing SmokeFreeOhio of deliberate deception. I opined that they may simply have made errors in reporting the science. Now, however, it is clear that the organization has paid careful attention to some of these claims. It is more difficult to explain this as a simple mistake. You don't claim that secondhand smoke causes emphysema, it seems to me, by some sort of mistake. It's not like anyone else is making that claim and they are just transmitting false information, or they are exaggerating some studies.

We'll see what their response is to this, but it is certainly beginning to look like SmokeFreeOhio is doing its best to try to impress the public about the health effects of secondhand smoke, and that they are not willing to rely on the truth to accomplish that. It appears to me that this is either deliberate deception or else very poor science.

Monday, September 18, 2006

According to an article appearing Friday in the Maryland Gazette, another anti-smoking group has publicly expressed its support for policies that discriminate against smokers by refusing to consider them for employment.

The article discusses the wave of employer policies that aim to save health care costs by refusing to hire smokers, such as those adopted by Scotts Miracle-Gro and Weyco. These companies actually went so far as firing existing employees who were unable or unwilling to quit smoking.

According to the article: "The wider bans are 'the wave of the future,' said Kari Appler, executive director of the Smoke Free Maryland Coalition of Baltimore. But she had not heard about any companies in Maryland going so far as to not hire smokers. 'For many employers, this makes sense,' Appler said. 'They are concerned about the message they send to employees, customers and the general public.'"

Appler was countered, however, by frequent Rest of the Story commenter Michael J. McFadden, mid-Atlantic regional director of the Smoker's Club, who "pointed out that companies could conceivably save money by targeting nonsmokers who theoretically cost more in pension expenses because they tend to live longer. 'What if I'm running a company and want to save on pension plan expenses, so I fire people who are nonsmokers? If someone tried to do that, it would create an uproar,' said McFadden. ... As for an employer's right to hire only nonsmokers, whether a potential employee smokes should be just one of many factors considered, he said. 'Smoking should never be used as a litmus test for something as vital to fundamental rights as being considered for a job,' McFadden said."

The Rest of the Story

I find it quite unfortunate that the Smoke Free Maryland Coalition of Baltimore has publicly supported policies that discriminate against smokers in employment. And I think it is particularly unfortunate that the Coalition has argued that not hiring smokers to save money makes sense.

But most disturbing to me is the Coalition's statement that a reason for employers not to hire smokers is because of concern over the "the message they send to employees, customers and the general public."

What kind of message does the Smoke Free Maryland Coalition of Baltimore have in mind? That smokers are second class citizens who are undeserving of employment? That children of smokers should go hungry because no one ought to hire their parents? That there is no room in society for smokers?

Frankly, the message that the Smoke Free Coalition has sent to employees, customers, and the general public is that they are full of hatred towards smokers and want to punish them by deeming them unworthy of employment and depriving them of the opportunity to make a living and support themselves and their families.

Thank goodness that long-time Rest of the Story commenter Michael McFadden came to the rescue and put the Smoke Free Coalition in its place. He insightfully pointed out that the very same reasoning being used by the Coalition to support not hiring smokers could just as easily be used to support not hiring nonsmokers. And I would add: the same reasoning could be used to support policies by which employers refuse jobs to mothers of young children, women who are likely to become mothers, fathers of young children, and fat people.

McFadden rightly suggests that smoking could be considered as a factor in hiring decisions, but only on an individual level (not as a blanket policy) and not in isolation. And he correctly points out that the right to be considered for a job should be generally considered as a fundamental right that we should strive to protect.

I am proud that a Rest of the Story discussant has added such an important and thoughtful perspective to this public discussion, which has received tremendous exposure among the tobacco control community (it was featured as a headline story on the tobacco.org news website).

It is high time that the anti-smoking movement -- including its organizations and advocates -- take time to seriously consider what the Smoker's Club is saying, rather than to simply dismiss this and other smokers' rights groups outright because they oppose many tobacco control policies.

I think the Smoker's Club adds an important voice to the discussion, and this is one situation in which I'm extremely glad that this voice was highlighted in the debate. On this particular issue, the Smoker's Club put the anti-smoking movement in its place.

Friday, September 15, 2006

In a September 13 letter to his fellow University of California regents, state Lieutenant Governor Cruz Bustamante condemned a UCLA study for reporting findings that go against the prevailing belief that secondhand smoke is a cause of lung cancer in nonsmokers and for its having been used by opponents of smoking bans to help defeat a smoking ordinance in Missouri. The letter urges the Regents to adopt a policy refusing tobacco industry funding of research at the University of California.

The study, conducted by Dr. James Enstrom at the UCLA School of Public Health and Dr. Geoffrey Kabat at SUNY, Stony Brook and funded in part by the Center for Indoor Air Research (an organization funded primarily by tobacco companies), failed to find a significant association between secondhand smoke exposure and lung cancer risk.

Bustamante wrote: "As you may know, a $500,000 UCLA study, funded by the tobacco industry, was released in 2003 questioning the risk of developing lung cancer from second-hand smoke. Although the findings of this study conflict with respected state and national studies that offer evidence of the strong correlation between second-hand smoke and lung cancer, its results already were used in the defeat of an anti-smoking ordinance in Missouri. ... My questions are: What is the damage to the University of California? Does this hurt our state's reputation and our scientific credibility?"

The Rest of the Story

While I strongly support the proposal for the University of California to refuse tobacco industry funding of research in order to protect the academic integrity of the institution, I do not think it is the findings of the study that are problematic and I certainly don't think that the fact that the findings conflict with those of other studies is a reason to condemn this research.

In fact, I find it slightly scary that Lt. Gov. Bustamante seems to condemn this research because of its findings.

It was just yesterday that I posted about the Public Understanding of Science article which uses this exact paper (the Enstrom/Kabat study) to demonstrate the way in which the anti-smoking movement has become a Foucaultian truth regime. It is perhaps illustrative that just the same day as I blogged that article, Bustamante's condemnation of the very same study came out, and the condemnation was based primarily on the fact that the research came up with findings that ran counter to the established scientific truth according to the movement.

We cannot condemn research based solely on which way its findings come out. That is contrary to the scientific process and it is a way of silencing critics of a particular dogma. It is highly partisan and it makes good science impossible.

I am also troubled by a second basis for Bustamante's condemnation of this research: the fact that smokers' rights advocates in Missouri used it to oppose a smoking ordinance. A researcher does not have control over how his research is used. Anyone can take a piece of research and use it any way they choose. How can the research be condemned because of how someone chooses to use it?

Nothing in Bustamante's letter questions the validity of the research itself or the integrity of the specific methods used to investigate the relationship between secondhand smoke and lung cancer. Are we to gather from this that it is only the results, not the process by which the research was conducted, that render it academically unsound?

Bustamante's objectives are reasonable, but he provides the wrong rationale. It is not the findings that can render research unsound, it is the conduct of the research. And unless he is prepared to articulate what Enstrom and Kabat did wrong in their conduct of the research, he should not be condemning it.

Ultimately, the problem is not the research, it's the use of that research as a marketing tactic by the tobacco industry. Universities should not engage in tobacco-funded research because they have no business serving as a pawn in the public relations strategy of these companies. And universities can control whether they choose to allow the tobacco industry to use them as a cog in their public relations machinery, whose ultimate goal is to sell more deadly tobacco products.

About Me

Dr. Siegel is a Professor in the Department of Community Health Sciences, Boston University School of Public Health. He has 32 years of experience in the field of tobacco control. He previously spent two years working at the Office on Smoking and Health at CDC, where he conducted research on secondhand smoke and cigarette advertising. He has published nearly 70 papers related to tobacco. He testified in the landmark Engle lawsuit against the tobacco companies, which resulted in an unprecedented $145 billion verdict against the industry. He teaches social and behavioral sciences, mass communication and public health, and public health advocacy in the Masters of Public Health program.